How Can We Treat Chronic Pain Better ?

People across the country and world suffer from injuries and ailments that do not improve with normal medication and treatment. Surely there's a better way.

Hello, friends,

Last post, we talked about the cost of Diabetes medication and how it is made virtually inaccessible for some people.  Today we’re continuing on with the medical issues thread and exploring a different ailment, one I am intimately familiar with:  Chronic Pain.

The long-and-short of it all is, well, “how do you treat chronic pain without harming the patient?”  The answers may surprise you.

This topic was suggested by my dear friend Nicole Radice, a fellow traveler in this accursed situation.

What Is Chronic Pain?

One definition of chronic pain is “pain that lasts longer than 12 weeks despite medication and treatment.”  Basically, it’s pain that persists for a long time.  The cause can be virtually anything.  In my case, it’s from degenerative disc disease, particularly in my neck.  It can be neuropathic, such as any disease where your nerves are impacted.

The key here is that treatment and medication cannot solve it.  Pain caused by - say - a calcified tendon is bad, but it is also relatively treatable.  I’d know, I had one the size of a golf-ball in my rotator cuff that was removed in 2012.  This treatment did alleviate the shoulder pain, but did not solve the spine problems I had.  Of course, if the shoulder did not heal properly (Say, it became a Frozen Shoulder), that could have led to its own chronic pain issue.

Chronic Pain can be disabling, both conceptually, in that it’s too painful to engage in activities; and legally, as in the government can use it as a justification to provide you benefits.  Don’t worry, this Substack will eventually cover the absolute insanity that is the disability system in this country.

Chronic Pain can also lead to mental trauma. Creaky Joints, a website outcropping of ArthritisPower, cites a Psychological Medicine study to indicate that approximately 20% of chronic pain patients have considered suicide.  In 2018, Pat Anson of Pain News Network reflected on this topic as it related to the 2016 changes in CDC pain management guidelines that reduced the scope of opioid use substantially.

Also, Anson’s article cites a 40% rate of patients considering suicide.  Those numbers are not pleasant, but are necessary in understanding the issue, because I can testify first-hand that people who see no hope of a release from their agony will make terrible-seeming decisions. If my words don’t convince you, this story surely will.

Thankfully, things are beginning to change.

2022 Changes To How Chronic Pain Is Treated Matter.

In November of 2022, new revisions were made as to how pain management is performed.  I can’t pretend to be a doctor who understands all of the CDC’s regulations, but NPR did a brief review of them.  In general, it appears that an emphasis was placed on an individual patient’s needs, versus a systemic “opioids are bad” approach.  They’re still disfavored!  But at least now they are more likely to be considered when pain does not improve with standard medications.

Of course, individual state medical boards will have to agree with these changes, but there’s hope in the air for people like myself, whose pain is uncontrollable without opioids.

These changes mean that chronic pain patients will have evidence-based analyses to present in discussions with their doctor about how best to care for them.  They will also have leverage to bring to bear in the political world if state governments fail to approve new regulations.  This could hypothetically also provide an added level of job security through de-stigmatization, if someone’s job requires drug testing and opioids are seen as ‘problematic.’

These changes will undoubtedly save lives.

What Else Can Be Done For Chronic Pain Patients

Well, for starters, improving access to disability insurance for those with chronic injuries and pain can help.  There is an entire industry dedicated to helping people who file for disability get it, since it is frequently denied.  There’s also an entire industry dedicated to spying on people to make sure they aren’t “abusing” their claim of disability.

Improving access to financial and medical resources will improve health outcomes and, thus, quality-of-life for pain patients.  For example, there are specialty pharmacies that make customized, special-purpose medications for chronic pain patients with unusual needs.  

Improved trust between patients and doctors could lead to the prescription of medication that works for the patient.  It took me years to earn my doctors’ trust in order to receive opioids, and I’m hopeful that I’m a good example for them to consider other patients’ pleas for the same.  Cannabis has been explored as at least a partial replacement for opioids, and while I can testify that it has positive effects, it is not a perfect savior, both in terms of efficacy and in terms of side effects.  Paranoia, one of the side effects I’ve experienced, is not fun.

Access to resources such as physical therapy is key.  I cannot tell you how many times my insurance company has forced me to pay out-of-pocket for physical therapy because they’ve decided my condition “doesn’t benefit” from it.  What they choose not to acknowledge is that the primary reason my neck MRI’s at a two year interval were stable is because of two years of hard, oft-painful physical therapy!

Similar concerns apply towards psychotherapy, as well.  Sometimes just having a skilled professional who is passingly familiar with the experience chronic pain patients go through is a tremendous boon to those who suffer from it.  Being able to shed the mental burdens of chronic pain, such as feeling anxiety over having to go out and stand when standing is abysmally painful, is a huge relief.  Sometimes that’s what it takes to take a step forward.

De-listing certain medications from scheduling as controlled substances is a move that many might see is heavy with risk, but others might consider one worth taking. This would mean that certain formulations of medication could be purchasable without prescription, within legislatively-determined limits, similar to how pseudophedrine is limited. These limits could be exceeded with a prescription for the treatment of serious pain. I won’t name specific medications, and research would need to be done, but the UK has legalized certain ones for over-the-counter distribution.

Finally, it’s worth noting that the costs of treatment for chronic pain and injuries might not be covered by all insurance companies, and many who suffer from it do not have their own insurance in the first place.  A solution to this would be Medicare For All (I told you I’d spiral this into future medical articles), wherein the government would be picking up most-if-not-all medical tabs.  Making it easier for patients to get diagnosed and afford their treatments would be a huge help to them.

Thank you for reading The Progressive Cafe.  If this article has helped you, please consider signing up for our mailing list.  This article is by Jesse Pohlman, a sci-fi/fantasy author from Long Island, New York, whose website you can check out here.